USA Today, September 1994

THE PSYCHOLOGY OF BEAUTY: What are the Right Reasons for PLASTIC SURGERY? Aristotle said that "Beauty is a better recommendation than any letter of introduction," but is it? David Hume wrote in 1741 that "Beauty is not a quality in things themselves, it merely exists in the mind that contemplates them, and each mind perceives a different beauty." More than 2,000,000 cosmetic procedures are performed annually. There are 72,000,000 baby-boomers who are approaching their 40s and associate looking good with success. What do they want to achieve with cosmetic surgery, and are their expectations realistic? A plastic surgeon must be a keen psychologist and understand why a person decides to change some aspect of his or her appearance. There is a relationship between self-image and the desire to change one's looks. The surgeon must be aware of the patients psychological stability, mood, expectations, motivations and goals. A brilliant surgeon and scalpel can not retrieve an ailing marriage. Residency training programs in the U.S. do a superb job in teaching young doctors to master the technical skills required for plastic surgery, but little time is spent studying the appropriateness of such a procedure from the psychological aspect of the patient profile. Choosing the appropriate patient is as important as selecting the correct procedure. Physical appearance is one clue to determine whether or not the patient is a good candidate. Is the patient disheveled? Does he or she have a defect which is only minimal? Has the patient already had a number of plastic surgery procedures performed? In other words, is he or she a plastic-surgiholic? Is the patient a super-perfectionist or a shopper? The manner in which the patient conducts himself or herself during the initial consultation is important. Is he or she rude, overly solicitous, critical of other surgeons, depressed, arrogant, or vague? Any one or a combination of these elements can signal unrealistic expectations. Such a person can never be satisfied. During the evaluation, it should be determined whether the patient has suffered a loss. Has he or she lost a job or a loved one? Changes in ones life can produce tensions. Some individuals are prompted to seek plastic surgery as a means to cope with added stress. Moreover, if the patient is undergoing psychological treatment, he or she may not be in a position to make a fully informed decision about plastic surgery. Even if the aforementioned elements are not present, I still may choose not to perform surgery on an individual with whom I do not feel comfortable. The final stage in the evaluation is whether he or she even is willing or capable of following instructions before the proposed procedure. If not, a surgeon seriously must reconsider whether to operate. There are limits to what can be accomplished by a plastic surgical procedure. Important variables such as a persons state of health, skin texture, age, and personality type will determine how close the operation will come to his or her expectations. Improvements may be expected, not perfection. A plain-Jane who is convinced that a facelift automatically will bestow ravishing good looks needs to be told a plastic surgeon can not create a Venus if the basic elements for beauty are not already there. The doctor is working with human skin, not clay. Such a patients needs to be advised that a facelift will not make her stunning, but render her free of wrinkles and impart a rested appearance. The ordinary looking man who persists in the belief that he can be transformed into an Adonis should be reminded of well-known people who fell short of popular standards of beauty. Winston Churchill is one example. Eleanor Roosevelt, Golda Meir, Indira Ghandi, and Margaret Mead became attractive with age. None of these women were graced with a face that could launch a thousand ships, but their charm, talent, and intelligence transformed them in the eyes of their beholders. There are yet others whose essence would be lost if they had undergone plastic surgery. Imagine if Barbra Striesand chose to have a rhinoplasty. Her voice would remain intact, but a surgically transformed proboscis would change forever her essence in the minds of others. Her nose is linked inextricably with her voice. It is part of her identity. Envision Yul Brynner with a hair transplant. Ralph Waldo Emerson once said that One man's identity is anthers ugliness. MEN SEEK A NEW IMAGE According to a survey conducted by the American Society of plastic and Reconstructive Surgeons, an increasing number of men are having aesthetic plastic surgery. They accounted for more than 25% of more than 70,000 nose jobs, 14% of 73,000 eyelid tucks, and 10% of 54,500 facelifts. Men no longer feel inhibited to consult with a doctor about aesthetic surgery. Males constitute about 20% of my surgery patients. An increased interests in aesthetic plastic surgery is connected with the social acceptance of self improvement. Everyone feels that plastic surgery no longer requires apologies. Men are pursuing facelifts and eye lifts in much the same fashion as they did hair styling years ago. Even skin care, once viewed with disdain, is now of concern to them. In addition to improving their physical appearance, plastic surgery can give men the winning edge. Many people have read or heard of the Wall Street Journal study that showed that promotions went to those who were younger looking and more attractive. It is also well-known that when two people of equal standing are considered for a position, the more attracted one is chosen. Ones emotional and psychological well-being should be a concern even after the procedure. The usual treatment process consists of a consultation, operation, and discharge, with a follow up visit in a week. It is a long process, and the recuperative period often is forgotten, which is ludicrous considering the amount of money people spend on the surgery. In Europe, some surgeons use health spas as a place for their patients to recuperate. With elective surgery, the patient is not really sick, so why prolong a stay in a hospital environment? In my practice, for example, patients have the option of recuperating in the Copley Plaza in Boston. There, they not only have the all the services and amenities of a luxury hotel, but the discreet and meticulous attention of its staff. Moreover, the cost is far less expensive than remaining in a hospital. Of course, the hospital is necessary for the actual surgery, and no one is discharged from it until he or she is stable and comfortable. The hotel stay eliminates the stress factor that many patients experience when they first arrive home. With most cosmetic surgery, there is some swelling, and anxiety can increase it and slow down the recovery process. Once thought of as mainly for the rich and famous, cosmetic surgery has become an important part of our youth and fitness oriented society. Plastic surgery offers another means to improve an individuals self-image if the patient has realistic expectations. While operations such as a facelift or tummy tuck may not be performed for physical health or safety, they often benefit patients emotionally and psychologically. At the same time, individuals must realize that plastic surgery is not a panacea. It is not the answer to life's problems. Cosmetic surgery can improve a person's appearance and self confidence, but only if the patient's state of mind is positive before the operation.